Results of Mannerfelt wrist arthrodesis for rheumatoid arthritis in relation to the position of the fused wrist

Purpose

The wrist is involved early in rheumatoid arthritis and is often severely affected. A stable wrist is crucial to good hand function, which often necessitates a fusion. One of the most commonly used techniques in rheumatoid patients is the Mannerfelt arthrodesis. In this retrospective study the outcome and the patient’s subjective satisfaction are presented and compared to other techniques. Also the influence of the position of the wrist following a fusion procedure is analysed.

Methods

Thirty-four wrists were retrospectively analysed using radiological measurements, functional scores such as the Disabilities of the Arm, Shoulder and Hand (DASH) and a pain assessment. The objective function of the hand with the fused wrist was assessed.

Results

In 92.6 % of wrists the patients rated their satisfaction as good or excellent. The mean DASH score post-operatively was 63.3. Of the wrists, 17 were fixed in a median flexed position of 13° and 17 wrists in a median extended position of 8°. There was no statistically significant correlation between the position of the wrist and the satisfaction or objective function. The rate of fusion was 94.1 %.

Conclusions

The Mannerfelt arthrodesis achieves good results and provides a high rate of satisfaction and pain relief in our study. It has major advantages compared to other wrist fusion techniques in the rheumatoid patient. We could not show clear statistical evidence for better results in either a flexed or an extended position, but the ratings of the patients indicated better subjective results with a slightly extended position of the arthrodesis.     

Radio-lunate arthrodesis in rheumatoid arthritis: outcome and techniques

Background and purpose

The wrist is one of the most affected joints in rheumatoid arthritis. The purpose of this retrospective study was to assess clinical, functional and radiographic results of radio-lunate arthrodesis. Two different operation and fixation techniques are compared and detailed outcome after this intervention is presented.

Methods

Twenty-seven patients with long-standing rheumatoid arthritis were operated on, either by stabilisation of the arthrodesis with Shapiro staples (n = 14) or by Herbert screw (n = 13) and followed for a mean of 5.4 years.

Results

Radio-lunate arthrodesis resulted in high overall and subjective satisfaction concerning function, grip and return to work. Grip strength was 35 kPa for the dominant and 26 kPa for the non-dominant hand. No revision, pseudoarthrosis or hardware failure was observed; only two conservatively treated wound healing problems were reported. The procedure resulted in a mean flexion of 26° and a mean extension of 24°; a clear improvement was also seen in activities of daily life. No difference between both groups was observed for pain, complication rate or functional outcome.

Interpretation

Due to high patient satisfaction and functional outcome, radio-lunate wrist arthrodesis can be recommended independent of fixation method.     

Langzeitergebnisse nach Handgelenkdenervation

Background

This retrospective study examines long-term follow-up results after complete denervation of the wrist.

Patients and methods

Between 1994 and 2000 a total of 61 complete wrist denervations of 59 patients (median age at operation 46 years) were performed. In 2009 29 patients with 30 complete wrist denervations took part in a follow-up examination after an average of 10 years. The mobility of the wrist and the grip force were examined. Pain and satisfaction with the operation were determined by means of a visual analogue scale (VAS) (0–100). The patients were asked about pain reduction and how long it lasted. Further the DASH and the Mayo Wrist Score were evaluated. Radiographs of the denervated wrist were performed and the degree of the degenerative osteoarthritis was determined according to Knirk and Jupiter.

Results

In 7 of the 36 patients examined, a partial or total wrist arthrodesis was performed. These patients were excluded from the study. Pain was improved in 28 of the 30 denervated wrists examined, in 22 the improvement lasted until the follow-up examination, whereas in 6 the pain increased after a median of 90 months. The median pain intensity was 10 at rest and 50 with activity; the satisfaction was 90. The median of the extension/flexion was 81% and the grip force 82% in comparison to the opposite hand. The DASH Score was 25 and the Mayo Wrist Score 73.

Conclusion

Complete denervation of the wrist according to Wilhelm is a treatment option for the chronically painful wrist and can lead to good grip force, mobility, sufficient pain reduction and satisfaction in the long term.     

Partial wrist arthrodesis versus arthroplasty for distal radius giant cell tumours

Purpose

The purpose of this study was to evaluate the clinical efficacy of using the proximal fibular graft for partial wrist arthrodesis or arthroplasty after the resection of giant cell tumours of the distal radius.

Methods

Between February 2006 and August 2010, 14 patients (seven males, seven females; average age, 35.7 years) with grade II and III giant cell tumours of the distal radius were treated by tumour resection and autologous proximal fibular grafts to reconstruct the wrist in our hospital. Seven patients each were treated by wrist arthroplasty and partial wrist arthrodesis, and were followed up for 2.2–6.8 years (average, 3.9 years).

Results

All patients achieved primary healing. No tumour recurrence was observed during follow-up in any of the patients. No statistically significant difference in forearm rotation was observed between patients undergoing the two different treatments. However, wrist flexion-extension activities were significantly better and the wrist grip strengths were significantly worse in the arthroplasty group than in the arthrodesis group. The Musculoskeletal Tumour Society score did not significantly differ between the groups.

Conclusions

Overall, joint arthroplasty remains a favourable treatment with regard to the functional outcome for giant cell tumours of the distal radius; however, some of these patients may have a weaker grip strength. In comparison, partial wrist fusion appears to provide a durable and stable wrist with good long-term functional outcome.     

Validation of the IOF quality of life questionnaire for patients with wrist fracture

Introduction

Wrist fracture causes pain and decreased physical, social and emotional function. The International Osteoporosis Foundation has developed a specific questionnaire to assess quality of life in patients with wrist fracture. This questionnaire, including 12 questions, was validated in a multicentre study and compared with an osteoporosis-specific questionnaire (Qualeffo-41) and a generic questionnaire (EQ-5D).

Methods

The study included 105 patients with a recent wrist fracture and 74 sex- and age-matched control subjects. The questionnaire was administered as soon as possible after the fracture, at 6 weeks, 3 months, 6 months and 1 year after the fracture. Test–retest reproducibility, internal consistency and sensitivity to change were assessed.

Results and discussion

The results showed adequate repeatability and internal consistency of the International Osteoporosis Foundation (IOF) wrist fracture questionnaire. The discriminatory capacity between patients and control subjects was very high, with significant odds ratios for each question and domain. The IOF-wrist fracture questionnaire domain scores showed significant improvement after 3 and 6 months and some improvement from 6 months up to 1 year. The sensitivity to change was much higher for the IOF-wrist fracture total score than for Qualeffo-41 and EQ-5D.

Conclusion

In conclusion, the IOF-wrist fracture questionnaire appears to be a reliable and responsive quality of life questionnaire.     

Four-corner fusion of the wrist: clinical and radiographic outcome of 31 patients

Background

Four-corner fusion is a rational surgical option for the management of degenerative conditions of the wrist. Most related studies have compared four-corner fusion with scaphoid excision or proximal row carpectomy, with a variety of reported results. To enhance the literature, we performed this study to evaluate a series of patients with degenerative conditions of the wrist treated with four-corner fusion using 3 surgical techniques and to discuss the clinical and radiographic outcome of the patients.

Materials and methods

We retrospectively studied 31 patients (24 men, 7 women; mean age, 43 years; 9 heavy manual laborers) who underwent four-corner fusion of their wrists for degenerative conditions from 2005 to 2015. Internal fixation was done using multiple Kirschner wires (14 patients), headless compressive screws (8 patients), or a circular plate (9 patients). Mean follow-up was 4 years (1–11 years). We evaluated the clinical outcome with the Patient-Rated Wrist Evaluation (PRWE) score and fusion with radiographs.

Results

All patients experienced improvement of their pain, function, range of motion and grip strength (p < 0.05). Twenty-three patients (74 %) reported no pain, and eight patients reported mild, occasional pain. Twenty-one patients (68 %) were able to do usual and specific activities. Mean wrist motion improved to 70 % and mean grip strength improved to 85 % of opposite wrist. Two heavy manual labor patients requested a job modification because of wrist impairment. Radiographs of the wrist showed fusion of all fused joints in 28 (90.3 %) patients and partial fusion in three patients (9.7 %). No patient with partial fusion required a reoperation for symptomatic nonunion until the period of this study. Three patients experienced complications (10 %). Two patients treated with a circular plate experienced complex regional pain syndrome and painful implant impingement; another patient treated with Kirschner wires and headless compression screws experienced radiolunate arthritis from impingement of the lunate screw to the radius.

Conclusions

Four-corner fusion is a reliable limited wrist fusion technique that provides pain relief, grip strength and satisfactory range of motion in patients with degenerative conditions of the wrist. Partial union is more common with Kirschner wire fixation and complications are more common with circular plate fixation.

     

Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius

Background

The aim of this study was to compare non-bridging external fixation to palmar angular stable plating with respect to radiological outcome, wrist function, and quality of life.

Methods

One hundred and two consecutive patients (mean age: 63 years) were enrolled in the study. Fifty-two patients were randomized for plate osteosynthesis (2.4 mm, Synthes), 50 patients received non-bridging external fixation (AO small fixator). Objective (range of motion, grip strength), patient rated outcomes (quality of life, pain), and radiological outcome were assessed 8 weeks, 6 months, and 1 year after surgery.

Results

Loss of radial length of more than 3 mm was not detected in any group. Volar tilt was better restored by external fixation (7.2°) than by volar plating (0.1°). Wrist function was good in both groups. The external fixator was tolerated very well, and the quality of life assessment revealed comparable results in both groups. Osteoporosis was found in 54 % of patients and had no influence on radiological and functional outcome.

Conclusion

Non-bridging external fixation employing multiplanar K-wires is a suitable treatment option in intra- and extra-articular fractures of the distal radius even in osteoporotic bone.

Level of evidence

Prospective randomized trial, Level I.     

OSG-Arthrodese über einen posterolateralen Zugang mit der polyaxial-winkelstabilen Talarlock®-Platte

Objective

Safe arthrodesis of the ankle as well as load carrying capacity free of pain.

Indication

Painful arthritis of the ankle joint occurring idiopathic or posttraumatic, resulting from rheumatoid arthritis or neuromuscular diseases. Extensive bony defects in varus or valgus ankle deformities and after failed prosthesis. Complex hindfoot deformities in neurological disease, paralysis and instabilities. Joint destruction after infection.

Contraindications

Active osteitis, extensive skin ulcers in the approach area, periphery artery occlusive disease.

Surgical technique

Posterolateral skin incision. Sparing cartilage resection. Penetrating sclerosis zones. Reorientating anatomic positioning of the talus thereby correcting axis deformities. Talarlock^® plate positioning and tibiotalar arthrodesis.

Postoperative management

Full weight bearing in an arthodesis boot for 6 weeks. After bone grafting partial weight bearing (20 kg) in an arthrodesis boot for 8 weeks. Full weight bearing after 10weeks.

Results

Ten patients were operated on using this procedure. The follow-up time was 1 year. There were no complications requiring further surgical procedures. Ankle fusion and a good clinical outcome could be achieved in all cases.     

Less invasive surgery with wrist arthroscopy for distal radius fracture

Background

We developed a surgical procedure that can facilitate arthroscopic intervention for volar locking plate fixation for distal radius fracture (DRF) with a less invasive technique. This study is to investigate the effectiveness of our original procedure for the treatment of DRF.

Methods

One hundred fifty-five wrists of 153 consecutive patients underwent our original procedure: the plate presetting arthroscopic reduction technique (PART) for DRF. The fractures consisted of 37 extra-articular and 118 intra-articular fractures. The fractures were reduced, anatomical alignment was regained with the aid of an image intensifier, and the volar locking plate was preset. Wrist arthroscopy was then performed and the intra-articular condition assessed. If there were any residual dislocations of the intra-articular fragments, these were reduced arthroscopically, and soft tissue injuries were subsequently treated. The traction was then removed, and the plate was securely fixed. One hundred forty-five patients were followed up from 12 to 48 months. The final outcome was evaluated with the Mayo modified wrist score and Disability of the Arm, Shoulder and Hand questionnaire (DASH). The effectiveness of arthroscopy was also investigated.

Result

On arthroscopic inspection, intra-articular dislocations were found to be residual in 35.2 %, even if reduction seemed to have been achieved when viewed with the image intensifier. Scapholunate interosseous ligament injury was recognized in 28.9 %, and triangular fibrocartilage complex injury was observed in 63.2 %. The final outcome was 112 excellent, 31 good, and 2 fair. The mean DASH score was 4.1.

Conclusion

We developed the PART to simplify the combination of volar locking plating and arthroscopy. This technique was less invasive and effective in the treatment of DRF.     

Klinisch-funktionelle Nachuntersuchung verschiedener handchirurgischer Versteifungsmethoden

Background

Total and partial arthrodesis of the wrist are currently sophisticated treatment options for many advanced pathological changes of the wrist. This retrospective study analyzed the subjective and objective outcome of different wrist arthrodesis techniques, e.g. total wrist arthrodesis, scaphotrapeziotrapezoid (STT) bone fusion and midcarpal arthrodesis.

Materials and methods

Subjective physical and mental quality of life of 98 patients (total wrist arthrodesis n?=?43, STT fusion n?=?30 and midcarpal arthrodesis n?=?25) was measured using the DASH questionnaire. The range of motion and grip strength were analyzed in 48 patients (total wrist arthrodesis n?=?21, STT fusion n?=?17 and midcarpal arthrodesis n?=?10).

Results

Patients with partial wrist arthrodesis achieved a significantly better DASH score than patients with total wrist arthrodesis. Grip strength did not show any statistically significant differences between the two groups. Patients with STT fusion showed the best range of motion of the wrist.

Conclusion

Partial arthrodesis seems to be superior to total wrist arthrodesis. Patients profit from a higher physical and mental quality of life.     

Four-corner arthrodesis with a radiolucent locking dorsal circular plate: technique and outcomes

Background

Scaphoid excision and four-corner arthrodesis (FCA) is an acceptable motion sparing procedure used to treat wrist arthritis. Recently, a locking dorsal circular plate composed of polyether-ether-ketone has been introduced (Xpode®; TriMed Inc.). The purpose of this study is to assess the efficacy of this specific plate design with regard to FCA.

Methods

A retrospective chart review of all patients who underwent FCA with an Xpode® between January 1, 2008 and December 31, 2012 was conducted. Patients were contacted and asked to return to clinic for clinical and radiographic follow-up. Patient demographics, range of motion, grip strength, and complications were collected from medical records. Patients completed a patient-rated wrist evaluation (PRWE). A paired t test was used to compare means, and p values <0.05 were considered statistically significant.

Results

Twenty-six procedures (24 patients) were identified. One patient required full wrist fusion following the initial procedure. Of the 25 remaining wrists, arthrodesis was successfully achieved in 20 (80 %). Eleven patients (13 wrists, 52 %) returned to clinic for an average follow-up of 28 months. Mean wrist extension improved from 30 to 47°, and flexion decreased from 33 to 23°. Average grip strength was 77 % of the uninjured side. The mean PRWE scores for pain and function were 19.7 and 17.1, respectively. Five patients underwent additional operations (two hardware removals, two contracture releases, and one distal radial ulnar joint arthroplasty).

Conclusions

FCA with the Xpode® yielded reasonable results for pain and function and demonstrated a fusion rate of 80 %.     

Mediokarpale Teilarthrodese des Handgelenks mittels Spiderplatte

Objective

Pain relief while preserving wrist motion in advanced carpal collapse.

Indications

Advanced carpal collapse stage II/III due to scaphoid non-union, scapholunate ligament tear, idiopathic radiocarpal osteoarthritis, aseptic osteonecrosis of the scaphoid (Preisser??s disease). A relative indication is chronic midcarpal instability.

Contraindications

Osteoarthrisis of the lunate. Radiocarpal instability with ulnar translation of the wrist.

Surgical technique

Dorsal curved incision between the 3rd and 4th dorsal extensor compartment. Partial wrist denervation (posterior interosseous nerve). Raising of a radial pedicled capsule flap. Complete extirpation of the scaphoid without fragmentation. Cartilage removal of all the joint facets for arthrodesis. Reduction of the lunate and temporary fixation with K?wires between the triquetrum and capitate and the triquetrum and lunate. Milling the plate hole exactly in central position of the four carpal bones. The plate should not protrude from the bone to avoid impingement with the dorsal limb of the radius. Transferring of spongiosa harvested from the removed scaphoid into the arthrodesis gap. Fixation of the 8-hole plate with 2?screws in each of the four carpal bones. Fluoroscopy of the screw fitting. Control of the correct wrist articulation (motion test). Lavage of the wrist. Suture of the capsule flap. Redon drain, wound closure, dorsal splinting.

Postoperative management

Dorsal splint for 3?weeks; finger mobilization up to complete fist closure starting on postoperative day?1. From week 4?C6, active wrist motion, from week 7?C10 with increasing load. Return to work after 11?C12 weeks. CT scan in cases of delayed union, abnormal function, or persistence of pain.

Results

Between 2002 and 2008, 36?four-corner fusions (32?male, 4?female) with the spider plate were performed in 24 right and 12 left wrists. The mean age of the patients at surgery was 48?years (range 32?C71?years). Follow-up examinations were performed in 11 patients. The Krimmer and Rudolf scores were determined: 1?excellent, 7?good, 2?satisfactory, and 1?poor result were found. The mean grip strength was 51% relative to the opposite wrist. The mean range of motion (ROM) for wrist extension/flexion was 56% of the opposite side. Wrist extension/flexion averaged 24/0/32° and ulnar/radial deviation was on average 20/0/19°. Pain during activity was on average 2.2 based on the visual analogue scale (0?C10). One delayed bony union due to a screw breakage, which required total wrist fusion, was observed.     

Ultrasound evidence of the optimal wrist position for radial artery cannulation

Purpose

Radial artery cannulation is a common medical procedure for anesthesia and critical care. To establish the ideal wrist position for radial artery cannulation, we performed ultrasound examinations of the radial artery to investigate the effect of the angle of wrist extension on radial artery dimensions.

Clinical features

Measurements were performed in 17 healthy subjects and 17 surgical patients scheduled for coronary artery bypass graft (CABG) surgery. The radial artery was echographically visualized near the styloid process of the radius at the wrist. Radial artery dimensions were measured at wrist joint angles of 0, 15, 30, 45, 60 and 75°.

Observations

In both groups, radial artery height was affected by the wrist joint angle. Vessel height was decreased at 60° (one way ANOVA P = 0.027 vs 0°) and 75° (P < 0.001 vs 0, 15, 45°) in healthy subject and at 75° in CABG patients (P < 0.001 vs 0°). The mean differences in radial artery height at 0 and 75° were 0.33 ± 0.09 mm and 0.20 ± 0.06 mm for healthy and CABG patients, respectively. Vessel width was not affected by wrist joint angulation up to 75° of extension.

Conclusion

Our results demonstrate that in healthy subjects, radial artery dimensions are unaltered when the wrist joint is extended up to an angle of 45°. Extension at 60° for healthy subjects and 75° for CABG patients, however, results in a decrease in the height of the radial artery, which could possibly render arterial catheterization more difficult.     

Corrective osteotomy of the distal radius following failed internal fixation

Introduction

The purpose of this study was to quantify the clinical and radiographic outcomes after corrective osteotomy for malunions of the distal radius following failed internal fixation.

Materials and methods

Results of 18 patients (8 women, 10 men; mean age 41 years) are presented an average of 7 years after osteotomy of a malunited distal radius fracture. We assessed active range of motion, grip strength, radiographic alignment, pain and disability. Subjective and objective data were summarized using the modified Mayo Wrist Score and the point-score system of Fernandez.

Results

Wrist motion, pain and deformity improved with the operation in all cases. The modified Mayo Wrist Score averaged 79 points. The scale of Fernandez indicated ten good, two fair and six poor results.

Conclusions

The results of this study suggest that the operative correction of a distal radius malunion following an unsuccessful internal fixation can be achieved with outcomes comparable to those reported after initial nonoperative treatment.     

Operative Therapie bei skapholunären Bandverletzungen

Background

The purpose of this work was to retrospectively evaluate clinical and radiological results after surgical treatment for scapholunate ligament ruptures.

Materials and methods

Measurements of range of motion, strength, and angles, as well as postoperative score assessments were performed in 32 patients.

Results

The average mobility in the operated wrist was 52° for flexion, extension 57°, radial 24°, ulnar deviation 31° and forearm rotation outward 88° and inward 89°. The recovery of force was 89?% compared with the healthy hand. It showed an average skapholunar angle of 63°, a radioulnar angle of 22° and an average carpal height according to Nattrass of 1.49. Our patients rated the operation result with a median DASH score of 11 points (range 0–70.8 points). The median objective Mayo Wrist Score was 80 points (range 45–100 points).

Conclusion

Surgical treatment of scapholunate ligament rupture, especially against the background of carpal collapse, is a very satisfactory method with very good results in the objective function and strength, and a high level of patient satisfaction.     

Midterm functional outcome after dorsal capsular imbrication for posttraumatic instability of the distal radioulnar joint

Introduction

The dorsal capsular imbrication of the distal radioulnar joint (DRUJ) which was performed because of posttraumatic dorsal instability showed promising functional results after the first postoperative years. Therefore, we hypothesized that patients after capsular imbrication are characterized by good subjective and functional outcome measurements after a midterm period.

Materials and methods

Eleven patients (range 21–50 years of age; median 35 years of age) were examined after capsular imbrication of the DRUJ because of posttraumatic instability with a mean follow-up time of 72 months (range 46–114 months; median 66 months). Examination parameters included the determination of range of motion (ROM), grip strength, pain and functional outcome scores (modified Mayo wrist score (MMWS); Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score)).

Results

A mean DASH score of 6.7 (range 0–22.5) and mean MMWS of 91.8 (range 75–100) were measured. Grip strength reached 96.7 % of the contralateral hand. Range of motion reached at least 93.1 % of the contralateral hand. Eight of 11 patients regarded functional outcome and pain reduction as excellent. Six of 11 patients did not recognize a diagnosed instability of DRUJ as such. Ulnar-sided wrist pain was the apparent symptom in these cases.

Conclusions

Capsular imbrication of the DRUJ is a reliable and sufficient treatment option in case of posttraumatic dorsal instability. Since DRUJ instability is seldom recognized by the patients as such, a standardised diagnostic algorithm is mandatory to guarantee reliability and efficacy for identifying DRUJ instability.     

An exploration of patients’ expectation of and satisfaction with surgical outcome

Purpose

The majority of studies of surgical outcome focus on measures of function and pain. Increasingly, however, the desire to include domains such as patients’ satisfaction and expectations had led to the development of simple measures and their inclusion into clinical studies. The purpose of this study was to determine patients’ pre-operative expectations of and post-operative satisfaction with the outcome of their spinal surgery.

Methods

As part of the FASTER randomised controlled trial, patients were asked pre-operatively to quantify their expected improvement in pain and health status at 6 weeks, 6 and 12 months following surgery using 100 mm visual analogue scales (VAS), and to indicate their confidence in achieving this result and also the importance of this recovery to them. Patients were then asked to rate their satisfaction with the improvement achieved at each post-operative review using 100 mm VAS.

Results

Although differences between patients’ expectation and achievement were minimal 6 weeks post-operatively, there was a clear discrepancy at 6 months and 1 year, with patient expectations far exceeding achievement. There were significant correlations between failure to achieve expectations and the importance patients attached to this recovery at each post-operative assessment, but not with their confidence in achieving this result. Satisfaction levels remained high despite expectations not being met, with discectomy patients being more satisfied than decompression patients.

Conclusions

Patients’ pre-operative expectations of surgical outcome exceed their long-term achievement. The more importance the patient attached to a good outcome, the larger is the discrepancy between expectation and achievement. Despite this, satisfaction levels remained high. The impact of unrealistic expectations on outcome remains unclear.     

Sequelae of foreign bodies in the wrist and hand

Background

Penetrating injuries to the hand are a common occurrence in the emergency room, and embedment of foreign bodies is suspected in many of these cases. The existing literature offers little information on retained foreign bodies. The aim of this study was to identify characteristics, determine prevalence, and observe outcomes for retained foreign bodies in the wrist and hand.

Methods

Four hundred thirty-seven consecutive hand and wrist radiographs in 437 patients from the emergency department of a level 1 trauma center were reviewed for the presence of retained foreign bodies. Location, size, number, and type of foreign body were recorded. Patient demographics, mechanism of injury, associated injuries, and treatment were obtained from medical records. All subsequent hospital and outpatient encounters were reviewed. Follow-up period was 18 months (range, 1–40).

Results

Of 437 cases, 65 patients (15 %) had at least one retained foreign body. Nineteen patients underwent removal of foreign body at initial presentation. The average size of foreign bodies removed was 6 mm, compared to 3 mm for those retained. Of 46 patients where the foreign body was left in situ, two (4 %) developed symptoms directly related to the retained foreign body. One of these patients underwent removal.

Conclusions

This study supports the safe removal of foreign bodies which are easily accessible or when part of a broader procedure to repair injured structures. Otherwise, we advocate expectant management for all other patients, as the likelihood of persistent symptoms is low and only 2 % of retained foreign bodies required removal later.     

The Mannerfelt wrist arthrodesis – A study of patient-reported outcomes in a rheumatoid population

BackgroundWrist arthrodesis has been established as a mainstay form of surgical intervention in the rheumatoid wrist. Despite this however, there is a distinct lack of patient-reported outcome measure (PROM) studies justifying the efficacy of this procedure in rheumatoid disease. The aim of this study was to report any change in function or pain following the tunnel Mannerfelt wrist arthrodesis in a single surgeon series of rheumatoid patients over a 6 year period.Methods14 consecutive patients (15 wrists) who had undergone the Mannerfelt wrist arthrodesis were followed prospectively with a mean follow up period of 45 months. No patients were lost to follow up. The primary outcome measures included the validated Patient Rated Wrist Evaluation (PRWE) questionnaire and a satisfaction questionnaire.ResultsThe mean total pain score improved from 41 points preoperatively to 14.2 points postoperatively correlating with a 65.4% improvement in overall pain outcomes. The mean total functional score improved from 83.7 points preoperatively to 45.5 points postoperatively demonstrating a 45.6% improvement in overall function at the time of follow up.ConclusionsAll patients reported an overall improvement in pain and functional capacity. The satisfaction results were excellent. All patients reported that they would elect to have the procedure again with the vast majority being ‘very pleased’ with the outcome of their surgery (93.7% very pleased and 6.3% fairly pleased). The procedure enjoyed favourable mid-term results and we recommend the tunnel Mannerfelt wrist arthrodesis for improving both pain and level of function in this group of patients.